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Öğe Aborted Donor Hepatectomies for Living Donor Liver Transplantation: A Single Center Experience(Lippincott Williams & Wilkins, 2016) Kutluturk, Koray; Otan, Emrah; Dirican, Abuzer; Yilmaz, Mehmet; Isik, Burak; Ozdemir, Fatih; Ince, Volkan[Abstract Not Available]Öğe Alpha-fetoprotein and albumin inversely relate to each other and to tumor parameters in patients with hepatocellular carcinoma(Kare Publ, 2024) Carr, Brian; Guerra, Vito; Ince, Volkan; Isik, Burak; Yilmaz, SezaiBackground and Aim: Alpha-fetoprotein (AFP), an oncofetal protein and biomarker in hepatocellular carcinoma (HCC), has unclear roles and ac-tions.To evaluate the relationships between AFP, liver function tests, and HCC aggressiveness. Materials and Methods: A retrospective analysis of an HCC patient data-base was conducted to examine the relationships between baseline serum AFP values, liver function tests, and tumor characteristics. Results: Statistically significant positive trends were observed between AFP levels and both AST and bilirubin, along with negative trends between AFP and albumin. Significant correlations were also found between AFP and MTD, multifocality, and PVT. Increases in MTD, multifocality, and PVT were noted even at low AFP levels, indicating both AFP-independent and AFP-dependent processes. However, these parameter changes were minimal compared to the substantial changes in AFP levels. Relationships between AFP-related liver and tumor characteristics were found to be sim-ilar but inverse to those for albumin, with normal albumin levels associated with more favorable tumor characteristics. Additionally, serum levels of albumin and AFP were inversely related. Conclusion: AFP and albumin levels significantly, but inversely, correlate with tumor parameters, suggesting that albumin may suppress HCC func-tions and could serve as a potential prognostic marker.Öğe Anesthesia Care for Children With Fulminant Liver Failure: Report of Our Experience.(Wiley-Blackwell, 2014) Sahin, Taylan; Koca, Erdinc; Ince, Volkan; Ucar, Muharrem; Toprak, Huseyin Ilksen; Yilmaz, Sezai[Abstract Not Available]Öğe Attention for insertion of temporary cardiac pacemaker in liver transplant patients(Kare Publ, 2021) Ince, Volkan; Tasolar, Hakan; Yilmaz, Sezai[Abstract Not Available]Öğe Barolith as a rare cause of acute appendicitis: a case report(Turkish Assoc Trauma Emergency Surgery, 2013) Ince, Volkan; Isik, Burak; Koc, Cemalettin; Baskiran, Adil; Onur, AsimA barolith consists of inspissated barium associated with feces and is seen, rarely, after barium studies for imaging the gastrointestinal system. The barium used in such studies can enter the appendiceal lumen and, rarely, cause appendicitis by obliterating or narrowing the lumen of the appendix. The appendix fills with barium and the entire appendix is visualized in 80-90% of barium swallow or enema studies, and this is accepted as a reliable sign of a non-diseased appendix Post-examination retention of barium in the appendix is very common (90 similar to 95%), and 10% of the patients retain barium in the appendix beyond 72 hours. If the barium is retained for more than two months, complicated appendicitis can result. We present a 46-year-old male who was diagnosed with acute appendicitis due to a barolith and required an appendectomy three months after a double-contrast barium enema study. After barium studies, patients should be informed regarding retention of barium in the appendix and the possibility that it can cause acute appendicitis. Thus, if abdominal pain develops, the patient can be referred quickly to a medical center for the appropriate treatment and the complications of acute appendicitis can be prevented with early intervention.Öğe A Case Report of Excessive Inflammation After TACE That Mimicked Tumor Invasion of Adjacent Tissues(Sage Publications Inc, 2023) Ince, Volkan; Garzali, Ibrahim Umar; Usta, Sertac; Kutlu, Ramazan; Yilmaz, Sezai[Abstract Not Available]Öğe Co-existence of idiopathic cecal ulcer and incidental appendix carcinoid tumor(Aves, 2016) Ince, Volkan; Barut, Bora; Karakas, SerdarIdiopathic cecal ulcer or solitary cecal ulcer is a rare entity that can only be diagnosed by histopathological evaluation. Generally, it is diagnosed by histolopathological evaluation of biopsy specimens obtained by colonoscopy that is performed for lower gastrointestinal bleeding. It can also be diagnosed after surgical resection performed for acute abdomen or cecal mass mimicking malignancy. Cecal carcinoid tumor is a rare cause of this condition; however, coexistence of cecal ulcer and appendix carcinoid tumor has not been previously reported. In this case, we present a 73-year-old woman who clinically presented as acute appendicitis with cecal wall thickening, underwent right hemicolectomy and was subsequently diagnosed with cecal ulcer, serosal abscess and coexisting appendix carcinoid tumor.Öğe A Combination of Blood Lymphocytes and AST Levels Distinguishes Patients with Small Hepatocellular Carcinomas from Non-cancer Patients(Springer, 2021) Carr, Brian, I; Bag, Harika Gozukara; Ince, Volkan; Akbulut, Sami; Ersan, Veysel; Usta, Sertac; Isik, BurakPurpose HCC patients typically present at an advanced tumor stage, in which surgical therapies cannot be used. Screening ultrasound exams can increase the numbers of patients diagnosed with small tumors, but are often not used in patients at risk for HCC. We evaluated clinically available and cheap potential blood tests as biomarkers for screening patients at risk for HCC. Methods A comparison was made of commonly used blood count and liver function parameters in a group of patients (n = 101) with small HCCs (<= 3 cm) or without HCC (n = 275), who presented for liver transplantation in our institute. Results Significant differences were found for blood lymphocytes and AST levels. This 2-parameter combination was found to be significantly different between patients with small HCCs versus no HCC. Using the combination of lymphocytes and AST levels to dichotomize the HCC patients, only blood levels of alpha-fetoprotein among the tumor characteristics were found to be significantly different among the 2 HCC groups, as well as levels of blood total bilirubin, ALKP, and PLR ratio. The results were confirmed using a separate smaller cohort of non-transplanted small size HCC patients. Conclusion The combination of elevated blood levels of lymphocyte counts and AST levels holds promise for screening of patients with chronic liver disease who are at risk for HCC.Öğe Combinatorial effect of zoledronic acid and irradiation on the prevention of DMBA-induced precancerogenic changes in the mammary tissues of rats(Wolters Kluwer Medknow Publications, 2016) Gurocak, Simay; Karabulut, Aysun Bay; Tuzcu, Mehmet; Sahin, Nurhah; Temelli, Oztun; Ince, Volkan; Sahin, KazimBackground: At present, the rates of breast cancer are continuously increasing, with over a million new cases being diagnosed worldwide each year. Hence, the development of new breast cancer chemopreventive drugs with acceptable efficacy and toxicity that are suitable for use for a protracted period of time is urgently needed. The present study investigated the potential preventive effects of zoledronic acid [ZOL] and radiotherapy [RT], both alone and in combination, on precancerogenic changes on the breast tissues of females. Materials and Methods: Wistar rats were treated with 7,12-dimethylbenz [a] anthracene [DMBA] at the acute phase. Fifty female rats were divided into seven groups: Control group [I]; ZOL, group [II]; RT, group [III]; DMBA, group [IV]; DMBA + RT, group [V]; DMBA + ZOL, group [VI]; and DMBA + ZOL + RT, group [VII]. Results: The treatment of DMBA-exposed rats with ZOL and RT, both alone and in combination, successfully upregulates the transcriptional levels of Bax, caspase-3, caspase-9, p21, and BRCA 1 in mammary tissues, which may account for the elevated apoptotic activities observed and the eventual inhibition of tumor growth. The administration of RT and ZOL both alone and in combination was found to be effective for inhibiting the DMBA-induced precancerogenic changes on breast tissues and modulating the expression of apoptosis-associated proteins in the acute phase. Conclusions: The combination of RT and ZOL was more effective than either agent alone. Our results suggest that the administration of ZOL and irradiation in combination can offer maximal protection against DMBA-induced mammary precancerogenic changes.Öğe Comparison of Femoral and Radial Arterial Pressures for Goal Directed Fluid Therapy in Undergoing Liver Transplantation Recipients(Lippincott Williams & Wilkins, 2016) Ucar, Hacer; Colak, Yusuf Z.; Kitlik, Arzu; Ucar, Muharrem; Ince, Volkan; Toprak, Huseyin I.; Yilmaz, Sezai[Abstract Not Available]Öğe Comparison of Intracorporeal Knot-tying Suture (Polyglactin) and Titanium Endoclips in Laparoscopic Appendiceal Stump Closure: A Prospective Randomized Study(Lippincott Williams & Wilkins, 2012) Ates, Mustafa; Dirican, Abuzer; Ince, Volkan; Ara, Cengiz; Isik, Burak; Yilmaz, SezaiBackground: Laparoscopic appendectomy is a well-described surgical technique. However, concerns still exist regarding whether the closure of the appendiceal stump should be done with a clip, an endoloop, staples, or other techniques. Therefore, several modifications to the original technique with new materials have been introduced for appendiceal stump closure. The aim of this study was to compare intracorporeal (polyglactin) knot-tying suture with titanium endoclips in appendiceal stump closure during laparoscopic appendectomy. Methods: The study was carried out as a prospective randomized clinical trial between April 2010 and February 2011. Patients with a presentation of appendicitis were included into the study. Two groups were defined-patients with the titanium endoclip and patients with the knot-tying (polyglactin) suture. The results in terms of operating time, complication rates, and hospital stay were analyzed. Results: Sixty-one patients who underwent laparoscopic appendectomy were enrolled in the titanium endoclip group (n = 30) or the knot-tying (polyglactin) suture group (n = 31). No statistically significant differences were detected between the groups in terms of the distribution of age, sex percentage, appendix localization, and histopathologic diagnosis (P > 0.05). One patient required a second operation on postoperative day 10 because of intraperitoneal abscess. The mean operative time for the endoclip group (41.27 +/- 12.2 min) was shorter than that for the knot-tying group (62.81 +/- 15.4 min) (P = 0.001). No statistically significant differences were detected between the groups in terms of hospital stay, follow-up time, and preoperative and postoperative complications (P > 0.05). Conclusions: In laparoscopic appendectomy, using a titanium endoclip for optimizing and controlling the appendiceal stump closure is safe and is associated with shorter operation time. This also simplifies the procedure, so it can be a useful alternative to intracorporeal knot-tying for appendiceal stump closure.Öğe Comparison of liver resection and living donor liver transplantation in patients with hepatocellular carcinoma within Milan criteria and well-preserved liver function(Kare Publ, 2023) Karakas, Serdar; Yilmaz, Sezai; Ince, Volkan; Akbulut, Sami; Dalda, Yasin; Akatli, Ayse Nur; Kahraman, Aysegul SagirBackground and Aim: Liver resection (LR) and liver transplantation (LT) are curative treatments for hepatocellular carcinoma (HCC). The main pur-pose of this study was to compare the survival of LR and LDLT in patients with HCC within the Milan criteria. Materials and Methods: The results of the LR (n=67) and LDLT (n=391) groups were compared for overall survival (OS) and disease-free survival (DFS). Twenty-six of the HCCs in the LRs met the Milan and Child A cri-teria. Also, 200 of the HCC patients in the LDLTs met the Milan criteria, of which 70 also met the Child A criteria. Results: Early mortality was higher in the LDLT group (13.9% vs 1.47%; p=0.003). The 5-year OS was higher in the LDLTs than the LRs, but not statistically significant (84.6% vs 74.2%; p=0.287). However, 5-year DFS was better in the LDLT group (96.8% vs 64.3%; p<0.001). When the LRs (n=26) and the LDLTs (n=70) that met both Milan and Child A criteria were compared, 5-year OS was similar (81.4% vs 74.2%; p=0.512), but DFS was better in the LDLTs (98.6% vs 64.3%; p<0.001). Conclusion: LR can be justified as the first-line treatment for HCC patients who meet Milan and Child A criteria in terms of and OS.Öğe CONGENITAL TRANSMESENTERIC DEFECT : INTERMITTENT INTESTINAL OBSTRUCTION DUE TO INTERNAL HERNIATION(Istanbul Univ, Faculty Medicine, Publishing Office, 2011) Ince, Volkan; Isik, Burak; Gozeneli, Orhan; Ersan, Veysel; Koc, CemalettinInternal hernias are a rare cause of intestinal obstruction. Intestinal obstruction occurs as a result of herniation, developing of congenital or acquired defects. Mortality rates reach 20% if surgical intervention is not made on time. We describe a 27-years-old female patient complained of intermittent obstruction, with no history of previous operations, treated with timely surgical intervention when irreversible changes have not been developped in herniated small bowell by only the reduction of hernia and closure the transmesenteric defect.Öğe Deceased donor liver transplantation from donors with central nervous system malignancy: Experience of the Inonu University(Kare Publ, 2017) Ince, Volkan; Ersan, Veysel; Ozdemir, Fatih; Barut, Bora; Koc, Cemalettin; Isik, Burak; Kayaalp, CuneytOBJECTIVE: Liver transplantation from deceased donors with a central nervous system (CNS) malignancy has some risk of tumor transmission to the recipient. Though the risk is small, this group of donors is regarded as marginal. The use of marginal grafts may be an acceptable alternative practice in order to expand the donor pool in countries where there is a shortage of donated organs. The aim of this study was to examine and present the outcomes of liver transplantations performed using donors with a CNS tumor. METHODS: Between March 2002 and July 2017, 1990 (deceased donor: n=399, 20%; living donor: n=1591, 80%) liver transplantations were performed at the center. Of the 399 deceased donors, 17 (4.2%) had a CNS tumor. The data of donors with a CNS tumor and of recipients who survived for more than 1 month (n=11) were retrospectively reviewed. Demographic data, the grade of the CNS tumor, tumor transmission to recipient data, and survival rates were analyzed. RESULTS: Only 2 (18%) grafts were provided locally, 6 (54%) were offered to the transplantation center after all of the national centers had declined them, and 3 (37%) were made available to us by the national coordination center for patients with a documented notification of urgency. High-grade (grade III-IV) brain tumors were detected in 7 (64%) donors, while low-grade (grade I-II) tumors were found in 2 patients. The remaining 2 donors were not pathologically graded because the diagnosis was made radiologically. The 1-, 3-, and 5-year overall and tumor-free survival of the patients was estimated at 100%, 70%, and 45%, respectively. CONCLUSION: A median survival of 40 months (range: 13-62 months) was achieved in recipients of grafts from a donor with a CNS tumor and no donor-related malignant transformation was observed.Öğe Diaphragmatic Hernia Following Donor Hepatectomy(Lippincott Williams & Wilkins, 2016) Koc, Cemalettin; Ince, Volkan; Otan, Emrah; Ersan, Veysel; Barut, Bora; Baskiran, Adil; Ozdemir, Fatih[Abstract Not Available]Öğe Discordance among aggressiveness characteristics of hepatocellular carcinoma: Portal vein thrombosis and multifocality, related to tumor size, but not to serum alpha-fetoprotein level(Keai Publishing Ltd, 2023) Carr, Brian I.; Guerra, Vito; Ince, Volkan; Isik, Burak; Yilmaz, SezaiBackground and aims: Hepatocellular carcinoma (HCC) is characterized by several clinically important prognostic parameters, including portal vein thrombosis (PVT), tumor multifocality, and serum alpha-fetoprotein (AFP) levels, in addition to maximum tumor diameter (MTD). However, associations among these parameters have not been thoroughly examined. Thus, the study aimed to investigate the correlations among these HCC characteristics in a prospectively collected database.Methods: An 8080 HCC patient database derived from our weekly HCC council meeting was examined with respect to the correlations at baseline patient presentation between increases in MTD and changes in the percentage of patients with PVT, multifocality, or AFP levels.Results: The percentage of patients with PVT and with multifocality (tumor nodule numbers >= 3) significantly increased with enlarging MTD, regardless of the serum AFP level, showing the indepen-dence of PVT and multifocality on AFP. The percentage of patients with multifocality increased with enlarging MTD, in the presence or absence of PVT, showing the independence of multifocality from PVT. Therefore, discordance was found between different tumor parameters.Conclusions: A statistically significant association was found between PVT and MTD and between mul-tifocality and MTD, all three of which are independent of AFP. PVT and multifocality appeared to be independent of each other. Although PVT and multifocality were independent of AFP, they were also augmented with high serum AFP levels. The results suggest the possibility of multiple pathways of tumor progression in the later stages of HCC development.(c) 2023 The Third Affiliated Hospital of Sun Yat-sen University. Publishing services by Elsevier B. V. on behalf of KeAi Communications Co., Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Öğe Does Preoperative Transarterial Chemoembolization for Hepatocellular Carcinoma Increase the Incidence of Hepatic Artery Thrombosis After Living-Donor Liver Transplant?(Baskent Univ, 2017) Ince, Volkan; Ersan, Veysel; Karakas, Serdar; Kutluturk, Koray; Karadag, Nese; Kutlu, Ramazan; Yilmaz, SezaiObjectives: Transarterial chemoembolization is a potential risk factor for hepatic artery damage, which may lead to severe consequences. We aimed to investigate this controversial issue in our population of liver transplant patients with hepatocellular carcinoma. Materials and Methods: Between March 2006 and December 2016, a total of 262 patients with hepa-tocellular carcinoma underwent liver transplant at our institution. Of these, 22 (8.4%) had preoperative transarterial chemoembolization. We retrospectively reviewed the data of all patients, comparing those who did and did not undergo transarterial chemo embolization. Results: The groups were similar in terms of patient sex, mean age, mean alpha-fetoprotein levels, and Milan criteria. The nontransarterial chemoembolization group had a significantly higher mean Model for End-Stage Liver Disease score. Hepatic artery thrombosis after liver transplantation was diagnosed in 6 of 22 patients (27%) in the transarterial chemoembolization group and in 12 of 240 patients (5%) in the non transarterial chemoembolization group (P = .002). Retransplant was performed in 5 of the 6 patients with hepatic artery thrombosis in the transarterial chemo embolization group and 3 of the 12 patients in the nontransarterial chemoembolization group (P = .04). Conclusions: In patients who undergo transarterial chemoembolization before liver transplantation, the incidence of hepatic artery thrombosis and retrans plantation is significantly higher than in those who do not undergo this intervention. The tissues should be carefully handled at the time of transplantation to prevent trauma that may cause intimal dissection in the fragile vessels.Öğe Effect of autotransfusion system on tumor recurrence and survival in hepatocellular carcinoma patients(Baishideng Publ Grp Co Ltd, 2013) Akbulut, Sami; Kayaalp, Cuneyt; Yilmaz, Mehmet; Ince, Volkan; Ozgor, Dincer; Karabulut, Koray; Eris, CengizAIM: To investigate the therapeutic efficacy and safety of continuous autotransfusion system (CATS) during liver transplantation of hepatocellular carcinoma patients. METHODS: Eighty-three hepatocellular carcinoma (HCC) patients who underwent liver transplantation with intraoperative CATS (n = 24, CATS group) and without (n = 59, non-CATS group) between April 2006 and November 2011 at the Liver Transplant Institute of Inonu University were analyzed retrospectively. Postoperative HCC recurrence was monitored by measuring alpha-fetoprotein (AFP) levels at 3-mo intervals and performing imaging analysis by thoracoabdominal multidetector computed tomography at 6-month intervals. Inter-group differences in recurrence and correlations between demographic, clinical, and pathological data were assessed by ANOVA and chi(2) tests. Overall and disease-free survivals were calculated by the univariate Kaplan-Meier method. RESULTS: Of the 83 liver transplanted HCC patients, 89.2% were male and the overall mean age was 51.3 +/- 8.9 years (range: 18-69 years). The CATS and non-CATS groups showed no statistically significant differences in age, sex ratio, body mass index, underlying disease, donor type, graft-to-recipient weight ratio, Child-Pugh and Model for End-Stage Liver Disease scores, number of tumors, tumor size, AFP level, Milan and University of California San Francisco selection criteria, tumor differentiation, macrovascular invasion, median hospital stay, recurrence rate, recurrence site, or mortality rate. The mean follow-up time of the non-CATS group was 17.9 +/- 12.8 mo, during which systemic metastasis and/or locoregional recurrence developed in 25.4% of the patients. The mean follow-up time for the CATS group was 25.8 +/- 15.1 mo, during which systemic metastasis and/or locoregional recurrence was detected in 29.2% of the patients. There was no significant difference between the CATS and non-CATS groups in recurrence rate or site. Additionally, no significant differences existed between the groups in overall or disease-free survival. CONCLUSION: CATS is a safe procedure and may decrease the risk of tumor recurrence in HCC patients. (c) 2013 Baishideng. All rights reserved.Öğe The effect of clinicopathologic findings of hepatocellular carcinoma on posttransplant survival: a multcenter cohort from TASL liver transplantation special interest group(Elsevier, 2022) Akyildiz, Murat; Gencdal, Genco; Ince, Volkan; Harputluoglu, Muhsin Murat; Bozkurt, Birkan; Zeytunlu, Murat; Kilic, Murat[Abstract Not Available]Öğe Effect of COVID-19 Pandemic on Patients Who Have Undergone Liver Transplantation Because of Hepatocellular Carcinoma(Elsevier Science Inc, 2023) Akbulut, Sami; Bagci, Nazlican; Akyuz, Musap; Garzali, Ibrahim Umar; Saritas, Hasan; Tamer, Murat; Ince, VolkanBackground and Aim. Many clinical studies have shown that the COVID-19 case fatality rate is higher in older patients, those with comorbidities, those with immunosuppressive conditions, and those who stay in the intensive care unit. This study aims to evaluate the clinical outcomes of 66 liver transplant (LT) patients with primary liver cancer who were exposed to COVID-19 infection.Methods. Demographic and clinical data of 66 patients with primary liver cancer (hepatocellu-lar carcinoma = 64, hepatoblastoma = 1, cholangiocarcinoma = 1) who underwent LT in our institute and were exposed to COVID-19 infection between March 2020 and November 2021 were analyzed in this cross-sectional study. The following data of the patients were recorded: age, sex, body mass index (kg/m2), blood group, underlying primary liver disease, smoking, tumor characteristics, post-transplant immunosuppressive agents, COVID-19 symptoms, hospi-talization, intensive care unit stay, intubation, and other clinical features. Results. There were 55 (83.3%) male and 11 (16.7%) female patients, with a median age of 58 years. Sixty-four patients were exposed to COVID-19 only once, whereas the remaining 2 patients were exposed 2 and 4 times, respectively. After exposure to COVID-19, it was deter-mined that 37 patients used antiviral drugs, 25 were hospitalized, 9 were followed in the inten-sive care unit, and 3 were intubated. One intubated patient was under hospital follow-up because of biliary complications before exposure to COVID-19, and this patient died from sepsis. Conclusion. The low mortality rate of LT patients with primary liver cancer exposed to COVID-19 infection can be attributed to background immunosuppression that prevents cytokine storm. However, it is appropriate to support this study with multicenter studies to make strong comments on this issue.
